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With the increasing reliance on computer tools and electronic records, infection preventionists may reasonably assume patients flagged for isolation on admission end up under the appropriate precautions.
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The elements of performance for the CAUTI prevention safety goal are as follows:
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Would you expect a New York Medicaid client to be able to access mental health service equally well, regardless of where he or she lived within the state?
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As a general rule, courts have upheld limitations on Medicaid reimbursements for services, as long as the services are "sufficient in amount, duration, and scope to reasonably achieve their purpose," according to Laura Hermer, JD, LLM, an assistant professor of health policy and bioethics at the University of Texas Medical Branch in Galveston.
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A new Medicaid recovery audit contractor (RAC) program will help strengthen the integrity of the Medicaid program, according to Xiaoyi Huang, JD, assistant vice president for policy at the National Association of Public Hospitals and Health Systems in Washington, DC. "That being said, we need to be cognizant of program integrity efforts that places undue burden on providers," she cautions.
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A state plan amendment submitted by North Carolina Medicaid to the Centers for Medicare & Medicaid Services (CMS) to participate with the Medicaid recovery audit contractor (RAC) program has already been approved, and a request for proposal will be released shortly, reports Brad Deen, a spokesperson for North Carolina Division of Medical Assistance (NCDMA).
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The Affordable Care Act (ACA) requires that state Medicaid agencies reimburse primary care providers at 100% of the Medicare fee schedule for two years, notes Donald Ross, manager of the policy and planning section at the Oregon Health Authority's Division of Medical Assistance Programs.
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Under a proposed rule published in May 2011 from the Centers for Medicare & Medicaid Services (CMS), state Medicaid agencies would have to review access to a subset of Medicaid-covered services every year, and review access to every Medicaid-covered service at least once every five years.
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New York state's Medicaid Visual Data Mining System allows state officials and policy makers to track the results of savings initiatives in real time, via a spending tracking website, according to Morris Peters, a spokesperson for the Division of Budget. (To view the site, go to http://www.health.state.ny.us/health_care/medicaid/regulations/global_cap/.)
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Washington Medicaid's plan to limit non-urgent ER visits to three a year is being watched "with great interest," says Randall Best, MD, JD, chief medical officer for North Carolina's Division of Medical Assistance. "It's a hot topic in pretty much all the states right now."
